title: Double jeopardy.
abstract: Torsades de pointes ("twisting of points") (TdP) is a broad complex tachyarrhythmia which was first described in 1966 by Francois Dessertenne and usually results from prolongation of the QT interval.(1) A wide variety of drugs have been shown to prolong the QT interval in susceptible individuals.(2) We present the case of a former intravenous heroin user presenting with several episodes of TdP which were caused by QT prolongation due to methadone treatment and exacerbated by hepatitis B/C infection. Despite aggressive medical treatment and withdrawal of methadone, he had recurrent episodes of TdP which required continuous temporary cardiac pacing for six days. He was found to have moderate LV dysfunction on his echocardiogram and unobstructed coronary arteries on coronary angiography. He underwent implantation of a defibrillator due to concerns about further episodes of ventricular arrhythmias which could recur even in the absence of further methadone use.
authors.affiliation: Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull HU16 5JQ, UK. Electronic address: damiencullington@hotmail.com.
authors.forename: Damien
authors.initials: D
authors.lastname: Cullington
authors.forename: Natalie
authors.initials: N
authors.lastname: Dunford
authors.forename: Stephen
authors.initials: S
authors.lastname: Beer
authors.forename: Neil
authors.initials: N
authors.lastname: Hobson
authors.forename: Sudipta
authors.initials: S
authors.lastname: Chattopadhyay
authors.forename: Joseph
authors.initials: J
authors.lastname: John
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D058850:Opiate Substitution Treatment; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000150:complications / Q000628:therapy*; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000628:therapy
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone